Facility Evaluation Report

On 04/09/2024 at 12:50 PM, Licensing Program Analyst (LPA) A. Gomez and A Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with House Manager, Alan Knowles and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Ambulatory. Administrator, Wardell Jackson arrived at 2:20PM

LPA toured facility with House Manager, Alan Knowles including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 3 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 112.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents.

Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 11/30/2023. LPA advised House Manager to update Emergency Disaster Plan to the full 9 pages. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 3/17/2024.

At 1:00 PM, LPA reviewed 4 residents records. Administrator agreed to send a copy of Surety Bond. At 1:30 PM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.